A gastroenterologist and a dietician will be guest speakers for the day’s program, which is free to attend. This is the first time the foundation is holding an educational event in Yakima.

For more info, contact Kathleen Newbould at 425-451-8455 or knewbould@ccfa.org.

I remember the tidal wave of emotions I felt after the birth of our first child. The fear and sense of responsibility driving home from the hospital. The sense of wonder watching him gaze at his surroundings. The joy in my heart seeing him coo or smile. Except for the times he had projectile vomiting, I wanted to be around this little guy all the time, awake or asleep. And so I was first confronted with the issue of co-sleeping.

Let’s first define what co-sleeping is in regards to this article.  Co-sleeping is when a parent sleeps next to his/her infant in the same bed. (Incidentally, my least favorite form of co-sleeping is in a motel room with family — usually because there is little sleep.)

What are some of the potential benefits of co-sleeping? Moms may not need to get out of bed to breastfeed. It may deepen the relationship between mother and child. And some may sleep better in this arrangement.

But studies indicate there are pitfalls to co-sleeping as well. The most important potential danger is SIDS (Sudden Infant Death Syndrome). Co-sleeping becomes more dangerous when parents use tobacco or alcohol or when a parent is overly tired or sleeps on a couch. The United Kingdom Department of Health advises that the safest place for an infant to sleep is in a crib in the parents’ room for the first six months of life. Similarly, the American Academy of Pediatrics, in a November 2011 report, recommends that baby can sleep in the same room as parents, but not in the same bed. Sharing a room is OK, but sharing a bed is not.

Let’s re-examine some of those purported benefits. If co-sleeping works while baby is small, fast-forward a year to when that toddler needs to graduate to his or her own bed — that could be a more difficult task. There are other ways to bond, as well: taking a walk, reading a book or playing games.

And on a related note, please place your baby on his or her back to sleep, and avoid blankets and toys in the crib (please see healthychildren.org for more information). The above AAP report also notes that immunizations and breastfeeding are associated with a lower incidence of SIDS.

Many mothers go the extra mile in pregnancy, avoiding over-the-counter medications, caffeine, soft cheeses and fish. Parents fill their homes with safety latches, gates and CO2 detectors. I would challenge parents to think of co-sleeping as a similar safety issue, where good choices can potentially save lives.

David Pommer, MD, is a family physician with Selah Family Medicine. He is a graduate of Whitworth University and the University of Washington School of Medicine. He co-sleeps with his pager, and he is happily married with three children.

It is a hassle to see the doctor.

The first battle typically involves the phone system. With carefully orchestrated options designed to keep you from reaching an actual person, it can be a minor miracle to reach the scheduler. Then, does your schedule match an opening for your doctor, if she or he has one?

Next up: the waiting room.

If your child wasn’t truly sick before arriving there, licking the waiting room toys might cinch the deal. When you are finally called back to the exam room, there is some momentary excitement, until you surmise that this is actually another smaller waiting room.

And don’t get me started on the redundancies of disclaimers and insurance paperwork.

—

I know what you’ve been through to get to see me. And I want to try to redeem the experience and make it as positive as possible. That doesn’t necessarily mean I’ll prescribe an antibiotic, however. Sometimes an antibiotic may be harmful rather than helpful.

Let’s take sore throats for example.

What percentage of sore throats are caused by strep bacteria and will benefit from an antibiotic? Only about 20 percent. The remaining are caused by viruses, and an antibiotic will not help.

And what about the color of mucous — is this important? I don’t like that green nasal drainage running down your child’s face either, but it turns out that whether it’s clear or colored does not matter. The color is caused by inflammatory cells, called neutrophils, that are present in both bacterial and viral infections.

Many bacterial infections are going to be self-limited. If a child is found to have an incidental ear infection, but is feeding well and not lethargic, he or she can probably get away with observation. A sinus infection should not be treated with antibiotics unless the patient has severe pain or symptoms have progressed past one week.

—

A study that affected how I prescribe was published in The Journal of Family Practice in 2000. It evaluated using a “backup” prescription, instructing families not to fill this unless the patient’s condition deteriorated or failed to improve. I may use this when an ear infection is mild, or if a sinus infection has not progressed beyond a week.

Sometimes people will request another antibiotic because the first one didn’t cure their infection, but it may be that the patient simply has a viral infection that just needs to run its course.

Why are physicians passionate about this topic? Possibly because contrary to the goal of the Hippocratic oath, they have done harm at times with antibiotics. Little Johnny may have had the sniffles before, but now with the help of antibiotics, he’s really got diarrhea and a diaper rash to boot. Antibiotic resistance (think MRSA) has proliferated with overprescribing. If you have a strong stomach, Google “Stevens-Johnson Syndrome” and you can see some of the dangerous rashes (and accompanying trial attorneys) that can rarely result from an antibiotic.

Now don’t get me wrong. I love the great taste of pink amoxicillin suspension as much as the next guy. But these medicines are a double-edged sword that need to be used at the right time in the right situation. So please don’t demand them.

And maybe I’ll see you in the waiting room with my own children, hoping to graduate to the next, smaller waiting room. We’ll try not to lick the toys.

 –David Pommer, M.D. is a family physician at Selah Family Medicine. He is a graduate of Whitworth University and the University of Washington School of Medicine. He is married with three children.

Dr. David Pommer works at Selah Family Medicine

By Dr. David Pommer for Playdate magazine

OK, I confess. I have not been a perfect role model about “screen time” with my patients and my family. But I think this is important to discuss as summer comes to a close and many of us retreat indoors.

What is screen time? The American Academy of Family Physicians defines this term as “watching television or DVDs, playing video or computer games and surfing the Internet.” A few years ago with patients, I would primarily ask about TV and video games, but now I need to inquire about cellphone screen time as well. As I will detail below, more screen time correlates with worse health.

Let’s take a quick self-assessment to see if this may be an issue with your family.

1) Do you use television as a baby sitter so you can get other things done at home?

2) Have you misplaced your library card months ago? … Or do you first check out the video section at your local library?

3) Do your children feel that happiness comes at Redbox?

4) Have you heard your child repeat a phrase in conversation that they likely heard from TV (for example, when I heard my son state “it’s fun for the whole family” when he wanted my wife and I to buy something, I knew he had been sitting too long in front of the boob tube).

If you answered “yes” to any of the above, keep reading.

According to a 2010 Kaiser Family Foundation study, the average child spends 7 1/2 hours per day in front of a screen. Another study broke this amount into about four or more hours of TV, videos and/or DVDs, more than one hour of computer time, and almost one hour of video games. Two out of three children ages 8-18 have a TV in their bedroom. And those kids who have a TV in their room watch almost 1½ hours more television per day than those who do not.

The consequences of this excessive screen time are more sobering.

The more time kids spend in front of a screen, the higher their risk of obesity. Obesity rates are lowest in children who have less than one hour of screen time per day, while they are highest in kids with greater than four hours per day. Screen time may also negatively affect body image and school performance and may correlate with increased violent behavior.

What is our remedy?

The American Academy of Pediatrics recommends limiting screen time to no more than one to two hours of “quality programming” per day. If there is a TV in a child’s room, I would recommend removing it. Use parental controls on your computer so a child has a set limit before he or she is logged off. Establish a “token economy” where kids need to earn their 1-2 hours by chores or reading earlier in the day. Though your children will not thank you now, hopefully their brains and waistlines will thank you in years to come.

David Pommer, M.D., is a family physician at Selah Family Medicine. He is a graduate of Whitworth University and the University of Washington School of Medicine. He is married with three children.

Toss out the food pyramid, folks…there’s a new way to make sure we’re eating right.

It’s called MyPlate, which the USDA and Michelle Obama unveiled in June.

OK, so the content and distribution of food items on the new design isn’t drastically different; the transformation lies in the presentation. The idea behind the change is to simplify our food-making decisions to help adults — and kids — make healthier choices. It’s also part of a campaign to help fight obesity in the U.S., with a heavy emphasis on increasing our intake of fruits and vegetables.

Unlike the food pyramid, all it takes is one glance to recognize a plate divided into four parts to represent four food groups: fruits, vegetables, grains and protein. The fifth food group, dairy, rests on the border of the plate and resembles a drinking cup.

Each section is a different size to emphasize how much consumers should eat of each group daily.

You can find more information at choosemyplate.gov.

–Scott Klepach, Jr

Here are some tips from choosemyplate.gov:

Eat less and avoid oversized meals

Make sure half of your meal is made up of fruits and vegetables

Make sure at least half of your grains are from whole grain products

Drink fat-free or low-fat (1%) milk

Look at labels for sodium content—then choose the foods with lower numbers

Instead of sugary drinks, drink water!  

In fact, according to the American Optometric Association, parents should plan on scheduling their baby’s first eye exam at 6 months of age.

That first eye exam can help detect any possible vision or eye problems early on. The association wants parents to view eye assessments as being just as important as visiting a pediatrician and a dentist, especially since many eye problems can develop with no symptoms.

Check with your eye doctor to see what he or she recommends and what you and your baby should expect for this first eye exam.

One program, InfantSEE, allows one no-cost eye and vision assessment for babies 6-12 months old.

Local InfantSEE Providers

Yakima

Dr. Christopher J. Babin: 1211 S. 40^th Ave. 509-966-2966

Dr. Roy W. Hinze: 5 S. 12^th Ave. 509-248-2020

Dr. Ed Labissoniere: 1121 S. 40^th Ave. 509-966-8801

Dr. Michael C. Noble and Dr. Donald T. Shute at Cascade Eye Center, 1211 S. 40^th Ave. 509-966-2966

Dr. Jeanette Marie Stromme: 111 University Parkway, Ste. 104. 509-966-0675

Union Gap

Dr. Seth Thomas Copeland and Dr. Benjamin C. Winters at Family Vision Care, located inside Costco. 509-454-5253

Selah

Dr. Dale K. Graf and Dr. Aaron D. Qunell at Selah Vision Clinic, 105 W. Orchard Ave. 509-697-6177

InfantSEE: 888-396-3937 or infantsee.org

Grant Porter, 15, is fitted with 3D glasses during his therapy with Dr. Winters. The 3D glasses and the large touch screen monitor is to test Porter's eye-hand coordination. (Photo by TJ Mullinax)

Kids face enormous pressures when they start each school year, with new challenges coming their way every day.

Since we rely on our senses to meet these challenges and learn and grow, it’s important to understand potential developmental problems that may arise in school-age children.

Our eyes are no exception.

For many, prescription glasses take care of poor vision. But for others, eye problems might develop that glasses or contact lenses can’t completely solve. One option more people are turning to is vision therapy.

Vision therapy has been an option for some years now, but it has been gaining popularity as research and technology develops to provide new ways of recognizing the many eye problems that exist and how to treat them.

Consider it physical therapy for not just the eyes, but the brain as well, says Dr. Benjamin Winters, an optometrist at Family Vision Care at Costco in Union Gap. Winters also practices vision therapy with Dr. Seth Thomas Copeland at Washington State Vision Center in Yakima.

The center opened last year to treat kids and adults, but its particular focus has been treating vision problems in school-age children. Although some of the kids who receive vision therapy already have prescription lenses, others have 20/20 eyesight, passing school vision screenings. The common link is that they all still struggle with reading and school performance.

Vision therapy is made up of weekly sessions at the clinic with exercises at home four times a week. The amount of time varies with each child depending on their eye problems; many kids are there for at least six months.

When Teresa Obert noticed reading problems in her son, Henry, she took him to vision therapy.  After a few months in vision therapy, Henry, now 10, made improvements and gained confidence.

“He couldn’t control the lens that focuses the eye,” says Obert. “He’s had the most progress there. Like a camera, the eye has to focus and refocus, and he couldn’t control that.”

Jett Black became good at memorizing information at school, but he also struggled with reading. It turns out that he was using his memory to compensate for his eye problems.

“We had him at four different eye doctors,” says his mother, Angela Noel. “He has 20/20 vision with a slight astigmatism. But something wasn’t right with his vision.”

One of Black’s difficulties is the ability to look at a shape and remember it. In his case, reading is difficult because each letter is a shape.

“He’s phonetically strong, but sight wise he is remembering patterns differently,” Noel says.

Black, 11, is also working on tracking, which will allow him to smoothly read each line of text.

“It’s still bumpy,” says Black, but being in therapy for several months had made reading a lot smoother.

Black also experiences suppression, when one eye shuts down due to the stress of trying to work at reading or receiving information.

“When his left eye is stressed, it shuts off,” Noel says. “It’s tough in school all day long. He gets exhausted.”

Black, who is a fifth-grader at Naches Valley Primary School, recognizes that when this happens, he gets irritable and tired. His teachers and friends have detected a positive shift in his attitude since he started vision therapy, and his grades have improved.

Shelby DeVore has also struggled with reading since Kindergarten. Many doctors told her and her mother, Lynn DeVore, that her eyes were fine. Yet she was unable to see the words in front of her, especially if they contained more than five letters.

Shelby has become a tactile learner because of her difficulty seeing.

“When she holds her pencil, she pushes on the paper so hard to feel what she’s writing. She can’t see it,” says Lynn. “It all came down to vision problems.”

Lynn says the goal is to have Shelby’s eyes work together. “They’re trying to teach her brain to do things automatically,” she says.

Unlike Shelby, Dominic Urlacher could see the words on the page, but he used to read very slowly.

“He’s always been tired by mid-morning, and he’d go take a nap,” says his mother, Sharon.

Dominic, 10, also had trouble in math. He found some improvement when he was prescribed glasses for his far-sightedness a year ago, but “it didn’t cut down on his tiredness, or learning,” says Sharon.

Dominic’s self-esteem was affected by his challenges, which include suppression and convergence insufficiency – essentially, his eyes not working together.

But Dominic is the very first graduate of the center in Yakima. He has completed his therapy program and can apply what he has learned in the years ahead.

The goal is not to have children in vision therapy forever. Instead, says Winters, it’s about teaching them to be aware of their eye problems and giving them the tools to fix them after they finish therapy.

“We’re excited [about] the journey,” says Lynn DeVore. “And we’ll definitely be excited to see the finish line.”

Story by Scott Klepach Jr.

Photos by Amber Miller

Sure, going to the dentist is not exactly the same as a day at the playground, but it doesn’t have to be a scary experience for kids, either. In fact, there are a number of pediatric dentists in the Yakima area who are trained to work with babies, toddlers and infants.

But when should you first take your kids to the dentist?

Local dentists, as well as the American Academy of Pediatrics and the American Academy of Pediatric Dentistry, agree that kids should have their first oral check by their first birthday, if not before.

“They should be seen at age 1 at the latest,” said Dr. Tyrone Rodriguez, a board-certified pediatric dental specialist with Apple Valley Dental & Orthodontics of Yakima. “If they’re 13 months (without an oral check), they’re overdue.”

Carlos Dorantes, doctor of dental surgery at Summitview Pediatric Dentistry of Yakima, agreed with this timeline, and added that if parents missed that window, they should take their child for a visit no later than six months after the first baby teeth have come in.

And that first oral check is fast and easy, said Ashley Tercero, a doctor of dental surgery at Yakima Pediatric Dentistry, and usually involves the dentist brushing, flossing and examining your baby’s teeth, and then applying fluoride.

Rodriguez said the first visit is a knee-to-knee exam, and he covers recommended eating habits with parents, what they should expect to see as their child’s mouth matures, and accident prevention.

“It’s not a thorough exam,” said Dorantes. “It’s more of a sit-down with parents on what to do when teeth come in, how to keep the mouth clean, what to use, and what not to use.”

This early check will also help children avoid anxiety about visiting the dentist’s office.

One question that typically comes up is, why do baby teeth need to be checked and fixed, if kids are only going to lose them?

“Baby teeth are the fruit at the top of the bowl, so if they go bad, what’s going to happen below?” said Rodriguez. “There could be possible irreversible damage.”

Tercero said cavities impact speech, growth and development, nutrition, sleeping, learning and overall health. Decay can also cause pain and infection, which can damage permanent teeth.

It is recommended that after kids receive their first oral check, they should be seen about twice a year, or every six months. Sometimes they might be seen more frequently if the dentist detects poor oral hygiene.

Proper Cleaning and Brushing

Tercero said children start getting their baby teeth at different times.

“Some get their first tooth at three months, others at one year. Parents shouldn’t be concerned about timing of teething,” said Tercero.

Instead, she said parents should make sure their children’s gums and teeth are clean to help lessen the pain that comes with teething.

“If the gums are healthy,” Tercero said, “it doesn’t hurt as much when the teeth break through.”

Dorantes said some parents are surprised they can and should start cleaning their baby’s mouth even if no teeth have come in yet. He suggested using a small cloth or a piece of tissue to wipe the mouth clean.

“This allows the child to have a clean mouth, and gets them in the habit of learning they have to do it, no matter what,” said Dorantes.

Kids should have assistance with brushing until they are about 7 or 8, said Tercero, and she suggests following the rule of “twos.”

“Brush two times a day for two minutes each time,” she said, adding that flossing is only necessary once a day.

Fluoride-free toothpaste and water will be sufficient for infants, she said, adding that kids can graduate to regular toothpaste that contains fluoride when they can spit it out.

Don’t Sugarcoat the Situation

“Caries,” which is the disease of having tooth decay, can be much more than an annoyance.

“It’s the number one childhood chronic illness,” said Dr. Joe Wilson, a pediatric dentist at ViewCrest Pediatric Dentistry in Yakima. “It is five times more common than asthma in children.”

Caries has been shown to lead to other health problems that can cause kids to be absent from school or miss out on other activities.

But a lot of families aren’t aware of this problem.

Tercero said the biggest oral health problem in the Yakima area is the amount of sugar that families have in their diet. Yakima kids have a much higher decay rate than those in Seattle, for instance.

“Most of this is due to our lack of good oral health education and our higher-than-average sugar intake,” she said.

Juice, while tasty and containing some good nutrients, is something that needs to be controlled.

“Most families think of juice as being a healthy thing for kids, but really it is more like ‘liquid candy,’” Tercero said.

“Think like a cheap bartender, and water it down,” Rodriguez recommended. “You’ll save money and you’ll save your child’s teeth.”

Dorantes said parents don’t need to eliminate entire foods out of their kids’ diets.

“It’s not what you give, but how often you give it,” he said. “The higher frequency of carbohydrate ingestion, the more likely a child may be at risk for having problems with teeth.”

Dorantes noted parents should be aware that refined carbohydrates – the stuff that can contribute to tooth decay – can be found in cookies, french fries, pastas and breads.

“It doesn’t necessarily need to be sugar per se to be a problem,” said Dorantes.

Tercero said a prolonged session of snacking can contribute to tooth decay because the sugar contained in most snacks has time to coat our teeth. Snacking in short sessions is preferred, so our saliva can do its job to clean the sugar off our teeth, which usually takes 20 minutes.

Overall, maintaining a healthy mouth doesn’t just help kids avoid cavities.

“Oral health is tied into systemic health,” said Wilson. “You can’t have one without the other.”

Wilson added there are three ways a person can get cavities: you have to have teeth; you have to have a sugar source, and you have to have bacteria present in the mouth. This last point is largely unknown or overlooked, he said.

“Think of it as a cold, and how bacteria is transferred,” said Wilson.

When parents or primary caregivers test the temperature of food for a child, for instance, that bacteria can transfer to the child’s mouth. For this reason, Wilson said it’s necessary for adults to maintain proper oral health, and expecting mothers should have cavities or other oral health problems fixed as soon as possible.

“It should be in the planning stages of having a child,” said Wilson.

Cause for Concern?

Other common concerns parents have include pacifier use, thumb sucking and teeth grinding. But these behaviors don’t necessarily turn into a problem for all kids.

Tercero noted that pacifier use and thumb sucking is normal and comforting for many infants and toddlers, but they can quickly turn into bad habits.

Dorantes said he looks for three things to determine if using a pacifier will become a bad or damaging habit: how long a child has been using the pacifier, how often during the day, and the intensity of use. Depending on those questions, he might try to wean a child off the habit.

Dorantes and Tercero agreed that it might be time to stop the pacifier use once a child turns 3, because the habit can possibly damage not just the teeth but also the shape of the palate, or roof of the mouth.

Teeth grinding is just as natural for children, and for the most part it’s not something to be worried about unless it persists after their adult teeth come in. Excessive grinding can cause small fractures or other problems, though, and the activity can point to other health problems, such as obstructed sleep apnea, difficulty sleeping and snoring.

Brace Yourself: See an Orthodontist Early

Most people don’t think about getting their kids braces until they hit junior high, but be prepared to have them checked out by an orthodontist years before this age, said Dr. Todd Steinhart, an orthodontic specialist at Apple Valley Dental and Orthodontics.

“Most orthodontists like to see kids for their first assessment at age 7 or 8,” said Tercero, though this isn’t the age that they start wearing braces. Instead, this consultation “allows the family and the orthodontist to come up with a plan for the future.”

At that stage, orthodontists can detect if any early treatment is needed, or if jaw surgery is needed.

“Most dentists are trained to spot these problems and will refer the patient to an orthodontist when needed,” said Tercero.

Toothy Trivia

• Kids have 20 baby teeth
• The complete set of baby teeth are usually in place by 3 years
• Front teeth come in around 6 months, first molars by age 1, the canines follow at 18 months, and finally the second molars appear around 2 years
• Kids can start losing their baby teeth around kindergarten, or age 6
• Kids will probably get their first set of adult molars in at age 6, and then the lower teeth follow
• Babies should stop using a bottle at 12-14 months to avoid “baby bottle tooth decay,” according to the American Academy of Pediatrics. At that point, drinking from a regular cup or sippy cup with a straw is best.

Recommended Books

Sure, we all know middle readers and young adult readers love reading about teeth – the sharper, the better, what with all those vampire stories taking a bite out of the juvenile fiction market. But before they get to the age to become “Twi-hards,” you might want to check out a few of these books that explore the world of dentistry. These are some titles your kids can cut their teeth on:

• The Berenstain Bears Visit the Dentist
• The Night Before the Tooth Fairy
• Teeth are Not for Biting (Board Book), by Elizabeth Verdick
• The Tooth Book
• The Tooth Book: A Guide to Healthy Teeth and Gums

Resource:

There is a helpful parents’ section on the American Academy of Pediatric Dentistry’s website, aapd.org.

When Tyler was born in 1997, everything was normal. Ten fingers, 10 toes, one miraculous little cherub. Somehow, amazingly, she was a part of me. I was in awe; every part of me wanted to protect this tiny being. Young and idealistic, her father and I decided to give her strong name, so that she would always be regarded as such.

I had no idea how strong she would have to be.

It wasn’t until Tyler was in fourth grade that she began to show serious symptoms. No matter how hard she worked, she couldn’t keep up with the girls on the basketball court. She complained about the pain in her joints when she ran, which her doctors attributed to growing pains. She tried not to get discouraged, but her coach was increasingly hard on her. It was difficult to watch.

It was during this year that she got an infection, which progressed into pneumonia. By her third round of antibiotics, I was getting worried. Countless frustrating trips to the doctor, tests, X-rays and blood draws gave us no diagnosis.

Tyler eventually couldn’t keep food down. Between vomiting and diarrhea, she endured abdominal pain like I’ve never seen. From February to June in 2007, she lost 18 pounds and weighed in at a mere 78 pounds. She was wasting away.

Tyler and I had moved from Florida, where she was born, when she was just 2. Eight years later, I was a single mom working on commission in a new job I loved and struggling to support my small family with little to no help from her father. It became difficult to focus at work. I stayed home when she really needed me, but as a single parent I had to keep working.

My mom used all of her vacation and sick leave helping me care for Tyler. I alternated between feelings of helplessness, guilt and stress. Little did I know that both Tyler and I were learning valuable lessons: I learned how to be an advocate for my child. Tyler learned, at the tender age of 9, how to live up to her name.

In late May 2007, we were finally referred to Seattle Children’s Hospital, though we had to wait for weeks to get in. By this time Tyler, an intelligent, clever child, took another turn for the worse: On May 31, I saw a toilet full of blood without the presence of stool, and Tyler experienced pain that dropped her frail little body to the floor. We called Seattle Children’s and they said she needed to be seen immediately. Mercifully, it was the day her health insurance became effective.

After a colonoscopy and an upper GI, the diagnosis was Crohn’s Disease.

The disease was present in 11 areas the doctors could see, from her esophagus to her colon.

There is no known cause or cure for Crohn’s. It is a chronic condition, with some cases much more severe than others. Crohn’s is an autoimmune disease that acts as an opportunist: when the body’s immune system is weakened it attacks the digestive tract. In Tyler’s case, she had an infection, then pneumonia. Her Crohn’s had been there for years, but very mild, as evidenced by her joint pain and stomach troubles. When her immune system was compromised, her body could no longer fight it off.

Since that first trip, Tyler has also been diagnosed with Ulcerative Colitis (UC), which is closely related to Crohn’s, as well as Arthralgia, which is joint pain. Crohn’s and UC fall under the classification of Inflammatory Bowel Disease (IBD).

The diagnosis, however, brought little relief. There are myriad ways to treat Crohn’s, including special diets and a battery of medications, but the side effects can be brutal. We simply had to try each one and figure out which worked. Tyler’s youth complicates matters, since many medications aren’t even approved for use in children.

Finally, in December, after 11 months on the job with a chronically ill child, I had to leave work. The pressure was unbelievable. By that time Tyler needed full-time care. I took care of her during the day, and my mom would sit with her at night so I could take a part-time job. For most of her sixth-grade year, I home-schooled Tyler, because more often than not she could not attend classes. At that time, I was giving her weekly Methotrexate injections (which are also used to treat some forms of cancer).

The side effects made her miserably ill, and after several months she absolutely refused treatment. After stopping the Methotrexate injections, she was able to go back to school, though she missed about 40 percent of her classes.

Crohn’s is such a frustrating disease because it is isolating. The symptoms aren’t discussed in polite society. Our joke is that it’s not “dinner conversation.” Tyler was depressed in a way I couldn’t comprehend. She couldn’t understand why this had happened to her, and couldn’t find escape from the constant pain. Depression is very common in Crohn’s patients — I can see why.

In order to manage and treat Tyler’s Crohn’s, there were several things that had to be addressed. In order to stop the bleeding, we would have to control the inflammation, and give her intestines a chance to rest and heal. Since treatments vary, we have tried countless medications in various combinations, and her medications change based on her symptoms. With each medication there are factors to weigh, kind of a cost vs. benefit analysis. How sick is it going to make her? Can she stand it? There were pitfalls during treatment that we didn’t expect: Two years ago while receiving her seventh Remicade infusion at Seattle Children’s, she went into anaphylactic shock.

Tyler is currently taking injections of Humira, which is prescribed for patients with severe Crohn’s who do not respond to any other treatments. Tyler also has a restricted diet, has to get substantial rest and is supposed to avoid stress, which exacerbates her condition. That last one always makes me laugh — the irony!

After 41 months, she is doing much better and has learned to deal with her condition. She is still symptomatic every single day — some days much worse than others. She now only misses about 20 percent of school, which is a great improvement.

As her mother, I have seen her go through unspeakable pain. But I have seen the frailty of a 9-year-old replaced by the strength and sharp new wit of a 13-year-old who has been through more than most adults. She has a new determination that I never had.

I have also witnessed grace. The first time she had to receive a Remicade infusion in Seattle Children’s oncology unit, Tyler realized it could be worse. Following that treatment, I heard her singing a song she wrote about how beautiful all of the children were, though they looked different on the outside. I cried as I secretly listened outside the bathroom door. Her strength and compassion continually amaze me.

Illustration by Kimberly Klepach

Parents have an endless list of things to worry about when it comes to their children, perhaps none more worrisome than food allergies.

Some skeptics say the increase in food allergies is an illusion fueled by parents’ worst fears and the media, but many doctors agree the rise in food allergies is a real problem, even if the reasons remain unclear.

“No one has any real understanding why there is such an increase,” said Dr. Nola Attaway, a pediatric allergist with Northwest Asthma and Allergy Center in Yakima. “In the countries that are industrialized, it’s moreso.”

“I see a lot of kids with food allergies,” said Dr. Heidi Robel, naturopathic physician and licensed acupuncturist in Yakima. “The question is, are we (simply) noticing it more? Yes, but it’s also increasing.”

A variety of foods will cause different symptoms. Robel said dairy, wheat and corn allergies typically produce eczema, chronic ear infection, worsened seasonal allergies, diaper rashes and even attention deficit hyperactivity disorder (ADHD). Nausea, vomiting, rashes and hives are other common symptoms. But other food allergies — those to peanuts, tree nuts and shellfish, especially — can be fatal.

“The body has made an antibody against a peanut,” said Attaway, adding that’s why symptoms can be so extreme.

One clear-cut and potentially fatal reaction is anaphylaxis, which can result from severe food allergies (to peanuts and other foods), bee stings or medication. Symptoms of anaphylactic shock might swelling of the lips and throat and difficulty breathing.

Attaway said it is important for parents of children with severe food allergies to have an anaphylaxis plan so they are fully prepared in the event a child goes into anaphylactic shock. This plan should cover mild and severe reactions. A few hives around the mouth with no other accompanying signs of shock — such as swelling of lips, trouble breathing, and fainting — can be treated first with an appropriate dose of Benadryl.

But symptoms can escalate quickly, and parents should have an EpiPen or similar auto-injector device always nearby. An EpiPen contains a dose of epinephrine, and when injected, the hormone can relieve a victim’s symptoms of anaphylactic shock — and ultimately become a lifesaver — until he or she can be taken to the emergency room.

Parents are advised to have their child tested if they are concerned about a food allergy, but doctors warn that individual tests may produce a false positive or false negative result.

“Someone may have a positive skin test, and be sensitive, but a skin test alone does not tell you they are allergic,” said Attaway.

Instead, a child might take both the skin-prick test and a blood test, but other factors are also considered, such as a record of suspected reactions and a look at any family history of various allergies.

“A lot of it depends on genetics. If dad has asthma and mom has seasonal hay fever, children have increased risk for food allergy,” Attaway said. “And if parents have some children who are allergic, that’s the biggest predictor of another sibling having a food allergy.”

Robel said diets today are not as clean as they used to be — foods are more refined and contain red and blue dyes, pesticides, hormones and antibiotics — which might cause more allergies. She recommends holding off introducing various foods to children until they reach a certain age.

“The immune system gets developed by two years of age,” said Robel. “Wait six months before introducing foods, and introduce fruits and vegetables first.”

Dairy, wheat and eggs should be introduced after six months, but Robel recommends waiting longer if there are allergies in the family.

Attaway said reading labels becomes essential for someone with a food allergy to avoid coming in contact with potentially fatal ingredients.

“Read the labels. If it says it may contain peanuts, avoid those,” Attaway said. “I’ve had patients come in who ate a blueberry muffin made on machinery exposed to peanuts. Those children who have a true, bona fide allergy should not eat those (foods).”

In fact, even the most unlikely foods could contain traces of peanuts: sauces, glazes, salad dressing, cookies, candy, pudding, specialty pizzas, some Asian and Mexican dishes, and pet food, according to the Food Allergy and Anaphylaxis Network (FAAN).

Attaway said many schools and day cares in the nation have gone nut-free, but she recommends that parents of children with food allergies pack a special goody bag of food and snacks so their kids don’t come in contact with other possibly problematic foods. Parents should also check with their child’s school about its policy regarding food allergies.

Attaway said there is a good chance children will outgrow certain food allergies, but most will continue to be prone to peanut, tree nut and shellfish allergies.

“They say up to 20 (percent) to 25 percent of children with (a) true peanut allergy can outgrow it, which is more than they used to believe,” she said. “But there’s no way of knowing which child can, and which child can’t.”

Children allergic to milk, wheat, egg and soy, however, have an 85 percent chance of outgrowing the allergy by age 8, and many of them show signs of outgrowing them by 3.

Jaclynn Bell’s children are living examples of how some people can outgrow a peanut allergy, even if their case is somewhat rare. All three of Bell’s children developed the allergy, but two of them outgrew it by age 4. Her second child, who is 2, still struggles with the allergy.

“The most difficult part of having a child with a food allergy is trying to explain the situation to someone who has never experienced or been around food allergies,” Bell said. “Having a peanut allergy can be one of the most dangerous allergies, and so many people don’t understand the severity of it. I have learned to read labels very well.”
Food Allergy or Food Intolerance?

Kids can react to foods in different ways, and it’s important not to assume they have food allergies.

“A lot of parents want to find a reason for it. Maybe it is an allergy, but there has been a lot of changes in food, with hormones and antibiotics,” said Dr. Judith Harvey of Yakima’s Family Medicine.

These changes could be contributing to the rise in adverse reactions in children, but Harvey advises parents to understand the difference between food allergies and food intolerance. She said while six percent of children suffer from some type of food allergy, up to one third of children experience food intolerance.

“Allergy and intolerance aren’t the same thing,” she said. “Diarrhea from cherries isn’t an allergy.”

Resources

Here are some great resources for parents of children with food allergies:

Mayo Clinic. The website lists the eight most common food allergies and their symptoms. These food allergies are milk, eggs, peanuts, tree nuts, fish, shellfish, soy, and wheat. The site also provides tips on reading labels properly and how to allergy-proof your house. mayoclinic.com/health/food-allergies/AA00057

Food Allergy and Anaphylaxis Network (FAAN). “This is the best resource for parents,” said Dr. Attaway. The website offers a wealth of information on all major food allergies and includes a link to a useful pamphlet called “The Peanut Answer Book.” Attaway noted that a toll free number is available any time of day or night if parents need to call to ask questions. foodallergy.org

Kids With Food Allergies. A non-profit organization that promotes and develops plans for children with food allergies to live nutritious and healthy lives. The group focuses on educating the public about food allergies and providing networking to those with food allergies. kidswithfoodallergies.org

Sunbutter is an alternative to peanut butter, and the company states it is peanut-free, tree nut-free, and gluten-free. The website also offers a variety of recipes to make the most out of the product as well as other safe ingredients. sunbutter.com